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Murphy L, Saab MM, Cornally N, McHugh S, Cotter P. Cardiovascular disease risk assessment in patients with rheumatoid arthritis: A scoping review. Clin Rheumatol 2024; 43:2187-2202. [PMID: 38733423 PMCID: PMC11189331 DOI: 10.1007/s10067-024-06996-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/19/2024] [Accepted: 05/03/2024] [Indexed: 05/13/2024]
Abstract
Patients with rheumatoid arthritis (RA) have an increased risk of developing cardiovascular disease (CVD). Identification of at-risk patients is paramount to initiate preventive care and tailor treatments accordingly. Despite international guidelines recommending all patients with RA undergo CVD risk assessment, rates remain suboptimal. The objectives of this review were to map the strategies used to conduct CVD risk assessments in patients with RA in routine care, determine who delivers CVD risk assessments, and identify what composite measures are used. The Joanna Briggs Institute methodological guidelines were used. A literature search was conducted in electronic and grey literature databases, trial registries, medical clearing houses, and professional rheumatology organisations. Findings were synthesised narratively. A total of 12 studies were included. Strategies reported in this review used various system-based interventions to support delivery of CVD risk assessments in patients with RA, operationalised in different ways, adopting two approaches: (a) multidisciplinary collaboration, and (b) education. Various composite measures were cited in use, with and without adjustment for RA. Results from this review demonstrate that although several strategies to support CVD risk assessments in patients with RA are cited in the literature, there is limited evidence to suggest a standardised model has been applied to routine care. Furthermore, extensive evidence to map how health care professionals conduct CVD risk assessments in practice is lacking. Research needs to be undertaken to establish the extent to which healthcare professionals are CVD risk assessing their patients with RA in routine care. Key Points • A limited number of system-based interventions are in use to support the delivery of CVD risk assessments in patients with RA. • Multidisciplinary team collaboration, and education are used to operationalise interventions to support Health Care Professionals in conducting CVD risk assessments in practice. • The extent to which Health Care Professionals are CVD risk assessing their patients with RA needs to be established.
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Affiliation(s)
- Louise Murphy
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland.
- Department of Rheumatology, Cork University Hospital, Wilton, Cork, Ireland.
| | - Mohamad M Saab
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Nicola Cornally
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
| | - Sheena McHugh
- School of Public Health, University College Cork, Cork, Ireland
| | - Patrick Cotter
- Catherine McAuley School of Nursing and Midwifery, University College Cork, Cork, Ireland
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Bedeković D, Bošnjak I, Bilić-Ćurčić I, Kirner D, Šarić S, Novak S. Risk for cardiovascular disease development in rheumatoid arthritis. BMC Cardiovasc Disord 2024; 24:291. [PMID: 38834973 DOI: 10.1186/s12872-024-03963-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Accepted: 05/28/2024] [Indexed: 06/06/2024] Open
Abstract
BACKGROUND Patients with rheumatoid arthritis have significant cardiovascular mortality and morbidity. OBJECTIVE To investigate the effects of chronic inflammation in rheumatoid arthritis on cardiovascular morbidity association with cardiovascular risk factors risk factors. Mortality report is secondary just to show trends without sufficient statistical power as it is accidental endpoint. METHODS A total of 201 individuals without previous cardiovascular disease, 124 with rheumatoid arthritis (investigation group) and 77 with osteoarthritis (control group), were included in the study and followed up for an average of 8 years to assess the development of fatal or non-fatal cardiovascular diseases. The incidence and prevalence of cardiovascular risk factors were also investigated. RESULTS The total incidence of one or more fatal or nonfatal cardiovascular events was 43.9% in the investigation group and 37.5% in the control group. Of these patients, 31.7% and 30.9% survived cardiovascular events in the investigation and control groups, respectively. The most common cardiovascular disease among participants who completed the study and those who died during the study was chronic heart failure. The results of the subgroup analysis showed that strict inflammation control plays a central role in lowering cardiovascular risk. CONCLUSION A multidisciplinary approach to these patients is of paramount importance, especially with the cooperation of immunologists and cardiologists for early detection, prevention, and management of cardiovascular risks and diseases.
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Affiliation(s)
- Dražen Bedeković
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Ivica Bošnjak
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia.
| | - Ines Bilić-Ćurčić
- Department for Pharmacology, Faculty of Medicine, J. J. Strossmayer University of Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Department of Endocrinology and Metabolism Disorders, Internal Medicine Clinic, University Hospital Centre Osijek, J. Huttlera 4, Osijek, 31000, Croatia
| | - Damir Kirner
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Sandra Šarić
- Department of Cardiovascular Diseases, Internal Medicine Clinic, University Hospital Osijek, J. Huttlera 4, Osijek, 31000, Croatia
- Faculty of Medicine Osijek, Department of Internal Medicine, University J.J. Strossmayer, J. Huttlera 4, Osijek, 31000, Croatia
| | - Srđan Novak
- Department of Rheumatology and Clinical Immunology, University Hospital Rijeka, Rijeka, Croatia
- Faculty of Medicine Rijeka, Department of Internal Medicine, University of Rijeka, Braće Branchetta 20/1, Rijeka, 51000, Croatia
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Yu KH, Chen HH, Cheng TT, Jan YJ, Weng MY, Lin YJ, Chen HA, Cheng JT, Huang KY, Li KJ, Su YJ, Leong PY, Tsai WC, Lan JL, Chen DY. Consensus recommendations on managing the selected comorbidities including cardiovascular disease, osteoporosis, and interstitial lung disease in rheumatoid arthritis. Medicine (Baltimore) 2022; 101:e28501. [PMID: 35029907 PMCID: PMC8735742 DOI: 10.1097/md.0000000000028501] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA)-related comorbidities, including cardiovascular disease (CVD), osteoporosis (OP), and interstitial lung disease (ILD), are sub-optimally managed. RA-related comorbidities affect disease control and lead to impairment in quality of life. We aimed to develop consensus recommendations for managing RA-related comorbidities. METHODS The consensus statements were formulated based on emerging evidence during a face-to-face meeting of Taiwan rheumatology experts and modified through three-round Delphi exercises. The quality of evidence and strength of recommendation of each statement were graded after a literature review, followed by voting for agreement. Through a review of English-language literature, we focused on the existing evidence of management of RA-related comorbidities. RESULTS Based on experts' consensus, eleven recommendations were developed. CVD risk should be assessed in patients at RA diagnosis, once every 5 years, and at changes in DMARDs therapy. Considering the detrimental effects of nonsteroidal anti-inflammatory drugs (NSAIDs) and corticosteroids on CVD risks, we recommend using the lowest possible dose of corticosteroids and prescribing NSAIDs cautiously. The OP/fragility fracture risk assessment includes dual-energy X-ray absorptiometry and fracture risk assessment (FRAX) in RA. The FRAX-based approach with intervention threshold is a useful strategy for managing OP. RA-ILD assessment includes risk factors, pulmonary function tests, HRCT imaging and a multidisciplinary decision approach to determine RA-ILD severity. A treat-to-target strategy would limit RA-related comorbidities. CONCLUSIONS These consensus statements emphasize that adequate control of disease activity and the risk factors are needed for managing RA-related comorbidities, and may provide useful recommendations for rheumatologists on managing RA-related comorbidities.
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Affiliation(s)
- Kuang-Hui Yu
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Memorial Hospital, Taoyuan, Taiwan
| | - Hsin-Hua Chen
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
- Faculty of Medicine, National Yang Ming University, Taipei, Taiwan
- Department of Industrial Engineering and Enterprise Information, Tunghai University, Taichung, Taiwan
- Institute of Biomedicine Science, National Chung Hsing University, Taiwan
| | - Tien-Tsai Cheng
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan
| | - Yeong-Jian Jan
- Division of Rheumatology, Allergy, and Immunology, Chang Gung University and Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Meng-Yu Weng
- Division of Allergy, Immunology, and Rheumatology, Department of Internal Medicine, National Cheng Kung University Medical College and Hospital
| | - Yeong-Jang Lin
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Hung-An Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Chi Mei Medical Center, Tainan, Taiwan
| | - Jui-Tseng Cheng
- Division of Allergy, Immunology and Rheumatology, Kaohsiung Veterans General Hospital, Taiwan
| | - Kuang-Yung Huang
- Division of Immunology, Allergy and Rheumatology, Buddhist Tzu Chi Medical Foundation, Dalin Tzu Chi Hospital, Chiayi, Taiwan
- School of Medicine, Tzu Chi University, Hualien City, Hualien, Taiwan
| | - Ko-Jen Li
- Division of Rheumatology and Immunology, Department of Internal Medicine, National Taiwan University Hospital
- College of Medicine, National Taiwan University Hospital, Taipei, Taiwan
| | - Yu-Jih Su
- Department of Medical Research, Taichung Veterans General Hospital, Taiwan
| | - Pui-Ying Leong
- Division of Allergy, Immunology and Rheumatology, Chung Shan Medical University Hospital, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Wen-Chan Tsai
- Division of Rheumatology and Immunology, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Joung-Liang Lan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
| | - Der-Yuan Chen
- Institute of Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Rheumatology and Immunology Center, China Medical University Hospital, Taichung, Taiwan
- College of Medicine, China Medical University, Taichung, Taiwan
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Ferreira MB, Fonseca T, Costa R, Marinhoc A, Carvalho HC, Oliveira JC, Zannad F, Rossignol P, Gottenberg JE, Saraiva FA, Rodrigues P, Barros AS, Ferreira JP. Prevalence, risk factors and proteomic bioprofiles associated with heart failure in rheumatoid arthritis: The RA-HF study. Eur J Intern Med 2021; 85:41-49. [PMID: 33162300 DOI: 10.1016/j.ejim.2020.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/16/2020] [Accepted: 11/02/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients have high risk of heart failure (HF). AIMS Identifying the risk factors and mechanistic pathways associated with HF in patients with RA. METHODS Cohort study enrolling 355 RA patients. HF was defined according to the ESC criteria. 93 circulating protein-biomarkers (91CVDIIOlink®+troponin-T+c-reactive protein) were measured. Regression modeling (multivariate and multivariable) were built and network analyses were performed - based on the identified relevant protein biomarkers. RESULTS 115 (32.4%) patients fulfilled the ESC criteria for HF, but only 24 (6.8%) had a prior HF diagnosis. Patients with HF were older (67 vs. 55yr), had a longer RA duration (10 vs. 14yr), had more frequently diabetes, hypertension, obesity, dyslipidemia, atrial fibrillation, and ischemic arterial disease. Several protein-biomarkers remained independently associated with HF, the top (FDR1%) were adrenomedullin, placenta-growth-factor, TNF-receptor-11A, and angiotensin-converting-enzyme-2. The networks underlying the expression of these biomarkers pointed towards congestion, apoptosis, inflammation, immune system signaling and RAAS activation as central determinants of HF in RA. Similar HF-associated biomarker-pathways were externally found in patients without RA. Having RA plus HF increased the risk of cardiovascular events compared to RA patients without RF; adjusted-HR (95%CI)=2.37 (1.07-5.30), p=0.034 CONCLUSION: Age, cardiovascular risk factors, and RA duration increase the HF odds in patients with RA. Few RA patients had a correct prior HF diagnosis, but the presence of HF increased the patients` risk. RA patients with HF largely share the mechanistic pathways of HF patients without RA. Randomized HF trials should include patients with RA. CLINICALTRIALS. GOV ID NCT03960515.
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Affiliation(s)
- Maria Betânia Ferreira
- Instituto de Ciências Biomédicas Abel Salazar, Porto, Portugal; Hospital da Luz Arrábida, Porto, Portugal
| | - Tomás Fonseca
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Rita Costa
- Centro Hospitalar Universitário do Porto, Porto, Portugal
| | | | | | | | - Faiez Zannad
- Centre d'Investigations Cliniques-Plurithématique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Patrick Rossignol
- Centre d'Investigations Cliniques-Plurithématique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France
| | - Jacques-Eric Gottenberg
- Department of Rheumatology, Referral Center for Rare Autoimmune and Systemic Diseases, Strasbourg University Hospital, Strasbourg, France; CNRS, Immunopathologie et Chimie Thérapeutique/Laboratory of Excellence Medalis, Institut de Biologie Moléculaire et Cellulaire, Strasbourg, France
| | - Francisca A Saraiva
- Department of Surgery and Physiology, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Portugal
| | | | - António S Barros
- Department of Surgery and Physiology, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Portugal
| | - João Pedro Ferreira
- Centre d'Investigations Cliniques-Plurithématique 1433, and INSERM U1116, CHRU, F-CRIN INI-CRCT (Cardiovascular and Renal Clinical Trialists), Nancy, France; Department of Surgery and Physiology, Cardiovascular Research and Development Unit, Faculty of Medicine, University of Porto, Portugal.
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Behl T, Kaur I, Sehgal A, Zengin G, Brisc C, Brisc MC, Munteanu MA, Nistor-Cseppento DC, Bungau S. The Lipid Paradox as a Metabolic Checkpoint and Its Therapeutic Significance in Ameliorating the Associated Cardiovascular Risks in Rheumatoid Arthritis Patients. Int J Mol Sci 2020; 21:ijms21249505. [PMID: 33327502 PMCID: PMC7764917 DOI: 10.3390/ijms21249505] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2020] [Revised: 12/07/2020] [Accepted: 12/12/2020] [Indexed: 02/06/2023] Open
Abstract
While the most common manifestations associated with rheumatoid arthritis (RA) are synovial damage and inflammation, the systemic effects of this autoimmune disorder are life-threatening, and are prevalent in 0.5–1% of the population, mainly associated with cardiovascular disorders (CVDs). Such effects have been instigated by an altered lipid profile in RA patients, which has been reported to correlate with CV risks. Altered lipid paradox is related to inflammatory burden in RA patients. The review highlights general lipid pathways (exogenous and endogenous), along with the changes in different forms of lipids and lipoproteins in RA conditions, which further contribute to elevated risks of CVDs like ischemic heart disease, atherosclerosis, myocardial infarction etc. The authors provide a deep insight on altered levels of low-density lipoprotein cholesterol (LDL-C), high-density lipoprotein cholesterol (HDL-C) and triglycerides (TGs) in RA patients and their consequence on the cardiovascular health of the patient. This is followed by a detailed description of the impact of anti-rheumatoid therapy on the lipid profile in RA patients, comprising DMARDs, corticosteroids, anti-TNF agents, anti-IL-6 agents, JAK inhibitors and statins. Furthermore, this review elaborates on the prospects to be considered to optimize future investigation on management of RA and treatment therapies targeting altered lipid paradigms in patients.
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Affiliation(s)
- Tapan Behl
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India; (I.K.); (A.S.)
- Correspondence: (T.B.); (S.B.); Tel.: +40-726-776-588 (S.B.)
| | - Ishnoor Kaur
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India; (I.K.); (A.S.)
| | - Aayush Sehgal
- Chitkara College of Pharmacy, Chitkara University, Punjab 140401, India; (I.K.); (A.S.)
| | - Gokhan Zengin
- Department of Biology, Faculty of Science, Selcuk University Campus, 42130 Konya, Turkey;
| | - Ciprian Brisc
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.B.); (M.C.B.); (M.A.M.)
| | - Mihaela Cristina Brisc
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.B.); (M.C.B.); (M.A.M.)
| | - Mihai Alexandru Munteanu
- Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania; (C.B.); (M.C.B.); (M.A.M.)
| | - Delia Carmen Nistor-Cseppento
- Department of Psycho-Neuroscience and Recovery, Faculty of Medicine and Pharmacy, University of Oradea, 410073 Oradea, Romania;
| | - Simona Bungau
- Department of Pharmacy, Faculty of Medicine and Pharmacy, University of Oradea, 410028 Oradea, Romania
- Correspondence: (T.B.); (S.B.); Tel.: +40-726-776-588 (S.B.)
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Buonora SN, Passos SRL, Daumas RP, Machado MGL, Berardinelli GM, de Oliveira DNR, de Oliveira RDVC. Pitfalls in acute febrile illness diagnosis: Interobserver agreement of signs and symptoms during a dengue outbreak. J Clin Nurs 2020; 29:1590-1598. [PMID: 32096283 DOI: 10.1111/jocn.15229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 02/02/2020] [Accepted: 02/08/2020] [Indexed: 11/28/2022]
Abstract
AIMS AND OBJECTIVES To compare and evaluate interobserver (nurses and physicians) agreement for dengue clinical signs and symptoms, including the World Health Organization diagnostic algorithm. BACKGROUND Agreement of clinical history defines the capacity of the examiner to measure a given clinical parameter in a reproducible and consistent manner, which is prerequisite for diagnosis validity. Nurses play a major role in the triage and care of dengue patients in many countries. STUDY DESIGN This is a sub-study on interobserver agreement performed as part of a cross-sectional diagnostic accuracy study for acute febrile illness (AFI) using the checklist STARD. METHODS A previously validated semi-structured sign and symptom standardised questionnaire for AFI was independently administered to 374 patients by physician and nurse pairs. The interobserver agreement was estimated using kappa statistics. RESULTS For a set of 27 signs and symptoms, we found six interobserver discrepancies (examiner detected red eyes, lethargy, exanthema, dyspnoea, bleeding and myalgia) as identified by regular and moderate kappa indexes. Four signs (patient observed red eyes, cough, diarrhoea and vomiting) and one symptom (earache) had near-perfect agreement. Most signs and symptoms showed substantial agreement. The WHO (Dengue guidelines for diagnosis, treatment, prevention and control: new edition, World Health Organization, 2009) clinical criteria for dengue comprise a group of symptoms known as "pains and aches." Interobserver agreement for abdominal pain, retro-orbital pain and arthralgia exceed that found for headache and myalgia. CONCLUSIONS During a dengue outbreak, the interobserver agreement for most of the signs and symptoms used to assess AFI was substantial. RELEVANCE TO CLINICAL PRACTICE This result suggests good potential applicability of the tool by health professionals following training. A well-trained health professional is qualified to apply the standardised questionnaire to evaluate suspected dengue cases during outbreaks.
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Affiliation(s)
- Sibelle Nogueira Buonora
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Sonia Regina Lambert Passos
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil.,Universidade Estácio de Sá, Rio de Janeiro, Brazil
| | - Regina Paiva Daumas
- Germano Sinval Faria Teaching Primary Care Center, National School of Public Health, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Matheus Garcia Lago Machado
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Guilherme Miguéis Berardinelli
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
| | - Diana Neves Rodrigues de Oliveira
- Laboratory of Clinical Epidemiology, Evandro Chagas National Institute of Infectious Diseases, Oswaldo Cruz Foundation, Rio de Janeiro, Brazil
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DeMizio DJ, Geraldino-Pardilla LB. Autoimmunity and Inflammation Link to Cardiovascular Disease Risk in Rheumatoid Arthritis. Rheumatol Ther 2020; 7:19-33. [PMID: 31853784 PMCID: PMC7021876 DOI: 10.1007/s40744-019-00189-0] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Indexed: 12/19/2022] Open
Abstract
Rheumatoid arthritis (RA) patients have a 50% increased risk of cardiovascular (CV)-related morbidity and mortality. This excess CV risk is closely linked to RA disease severity and chronic inflammation, hence is largely underestimated by traditional risk calculators such as the Framingham Risk Score. Epidemiological studies have shown that patients with RA are more likely to have silent ischemic heart disease, develop heart failure, and experience sudden death compared with controls. Elevations in pro-inflammatory cytokines, circulating autoantibodies, and specific T cell subsets, are believed to drive these findings by promoting atherosclerotic plaque formation and cardiac remodeling. Current European League Against Rheumatism (EULAR) guidelines state that rheumatologists are responsible for the assessment and coordination of CV disease (CVD) risk management in patients with RA, yet the optimal means to do so remain unclear. While these guidelines focus on disease activity control to mitigate excess CV risk, rather than providing a precise algorithm for choice of therapy, studies suggest a differential impact on CV risk of non-biologic disease-modifying anti-rheumatic drugs (DMARDs), biologic DMARDs, and small molecule-based therapy. In this review, we explore the mechanisms linking the pathophysiologic intrinsic features of RA with the increased CVD risk in this population, and the impact of different RA therapies on CV outcomes.
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Affiliation(s)
- Daniel J DeMizio
- Division of Rheumatology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Laura B Geraldino-Pardilla
- Division of Rheumatology, Department of Medicine, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
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Contreras-Yáñez I, Guaracha-Basáñez G, Pascual-Ramos V. Cardiovascular risk factors' behavior during the early stages of the disease, in Hispanic rheumatoid arthritis patients: a cohort study. Rheumatol Int 2019; 40:405-414. [PMID: 31606775 DOI: 10.1007/s00296-019-04451-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 09/25/2019] [Indexed: 01/27/2023]
Abstract
Rheumatoid arthritis (RA) patients from Latin America present distinctive characteristics relevant when assessing their cardiovascular (CV) risk. The objective was to monitor CV risk factor behavior in the early stages of the disease and to identify predictors of major CV outcomes (MACE). A recent-onset RA cohort was initiated in 2004; data from 185 patients with ≥ 1 year of follow-up were analyzed. Patients underwent prospective assessments of CV risk factors. Incident MACE were confirmed according to standardized definitions. Appropriated statics was used based on the distribution of the variables. At baseline, patients were primarily middle-aged females (87.6%), with active disease (69.7%). Most prevalent CV risk factors were C-reactive-protein > 1 mg/L (90.3%), Castelli ratio > 3 (83.8%), and low-high-density lipoprotein levels (73.5%). The number of patients with an incident CV risk factor after 1 year was higher for a Castelli ratio > 3 (23%), low-high-density lipoprotein serum cholesterol (16.3%), high total serum cholesterol (10.6%), and BMI ≥ 30 kg/m2 (10%). A minority of patients met the age-range criteria for the application of ACC/AHA 2013 criteria and Reynolds Risk Score (45.8% and 34.1%, respectively). Fifteen patients were classified with high-CV risk during the first year of follow-up, according to ACC/AHA 2013 criteria. Until June 2018, the cohort underwent 1358 patient/years follow-up; six patients developed incidental MACE; high-CV risk at baseline failed to predict MACE. Recent-onset RA Hispanic patients present a distinctive pattern and first-year behavior of CV risk factors. During follow-up, few patients developed incidental MACE.
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Affiliation(s)
- Irazú Contreras-Yáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia Belisario Domínguez, Sección XVI, CP 14080, Mexico City, Mexico
| | - Guillermo Guaracha-Basáñez
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia Belisario Domínguez, Sección XVI, CP 14080, Mexico City, Mexico
| | - Virginia Pascual-Ramos
- Department of Immunology and Rheumatology, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Vasco de Quiroga 15, colonia Belisario Domínguez, Sección XVI, CP 14080, Mexico City, Mexico.
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Ikdahl E, Rollefstad S, Wibetoe G, Salberg A, Krøll F, Bergsmark K, Kvien TK, Olsen IC, Soldal DM, Bakland G, Lexberg Å, Gjesdal CG, Gulseth C, Haugeberg G, Semb AG. Feasibility of cardiovascular disease risk assessments in rheumatology outpatient clinics: experiences from the nationwide NOCAR project. RMD Open 2018; 4:e000737. [PMID: 30305931 PMCID: PMC6173264 DOI: 10.1136/rmdopen-2018-000737] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 07/25/2018] [Accepted: 08/19/2018] [Indexed: 01/01/2023] Open
Abstract
Objective The European League Against Rheumatism recommends implementing cardiovascular disease (CVD) risk assessments for patients with inflammatory joint diseases (IJDs) into clinical practice. Our goal was to design a structured programme for CVD risk assessments to be implemented into routine rheumatology outpatient clinic visits. Methods The NOrwegian Collaboration on Atherosclerosis in patients with Rheumatic joint diseases (NOCAR) started in April 2014 as a quality assurance project including 11 Norwegian rheumatology clinics. CVD risk factors were recorded by adding lipids to routine laboratory tests, self-reporting of CVD risk factors and blood pressure measurements along with the clinical joint examination. The patients’ CVD risks, calculated by the European CVD risk equation SCORE, were evaluated by the rheumatologist. Patients with high or very high CVD risk were referred to their primary care physician for initiation of CVD preventive measures. Results Data collection (autumn 2015) showed that five of the NOCAR centres had implemented CVD risk assessments. There were 8789 patients eligible for CVD risk evaluation (rheumatoid arthritis (RA), 4483; ankylosing spondylitis (AS), 1663; psoriatic arthritis (PsA), 1928; unspecified and other forms of spondyloarthropathies (SpA), 715) of whom 41.4 % received a CVD risk assessment (RA, 44.7%; AS, 43.4%; PsA, 36.3%; SpA, 30.6%). Considerable differences existed in the proportions of patients receiving CVD risk evaluations across the NOCAR centres. Conclusion Patients with IJD represent a patient group with a high CVD burden that seldom undergoes CVD risk assessments. The NOCAR project lifted the offer of CVD risk evaluation to over 40% in this high-risk patient population.
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Affiliation(s)
- Eirik Ikdahl
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Silvia Rollefstad
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Grunde Wibetoe
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
| | - Anne Salberg
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Frode Krøll
- Department of Rheumatology, Lillehammer Hospital for Rheumatic Diseases, Lillehammer, Norway
| | - Kjetil Bergsmark
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Inge C Olsen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dag Magnar Soldal
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway
| | - Gunnstein Bakland
- Department of Rheumatology, University Hospital of Northern Norway, Tromsø, Norway
| | - Åse Lexberg
- Department of Rheumatology, Drammen Hospital, Drammen, Norway
| | - Clara G Gjesdal
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | | | - Glenn Haugeberg
- Department of Rheumatology, Hospital of Southern Norway, Kristiansand, Norway.,Department of Rheumatology, Martina Hansen's Hospital, Bærum, Norway
| | - Anne Grete Semb
- Department of Rheumatology, Preventive Cardio-Rheuma Clinic, Oslo, Norway
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10
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Adawi M, Pastukh N, Saaida G, Sirchan R, Watad A, Blum A. Inhibition of endothelial progenitor cells may explain the high cardiovascular event rate in patients with rheumatoid arthritis. QJM 2018; 111:525-529. [PMID: 29788448 DOI: 10.1093/qjmed/hcy099] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 04/30/2018] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Rheumatoid arthritis (RA) patients may suffer cardiovascular (CV) events much more than the general population, and CV disease is the leading cause of death in patients with RA. Our hypothesis was that impaired function of endothelial progenitor cells may contribute to endothelial dysfunction and the clinical CV events of patients with RA. METHODS About 27 RA patients (9 males and 18 females) with an active disease and 13 healthy subjects who served as the control group (nine males and four females) were enrolled to this prospective study. The ability to grow in culture colony-forming units of endothelial progenitor cells (CFU-EPCs) was measured, as well as their endothelial function using high-resolution ultrasonography of the brachial artery, and levels of C reactive protein (CRP) in the serum. For statistical analysis, we used the Student's t-test. RESULTS As a group, patients with RA were older (P < 0.0001), had severe endothelial dysfunction (P<0.0001), with impaired ability to grow CFU-EPCs (P<0.0001), and a higher inflammatory state (P = 0001). No difference was observed in BMI. All RA patients had an active disease (DAS28 3.9 ± 0.9) for 9.2 ± 6.5 years. The same differences were observed in both genders. CONCLUSIONS Patients with RA had an impaired ability to grow EPCs and severe endothelial dysfunction. Inability to grow colonies of EPCs reflects the impaired regenerative capacity of patients with RA and may explain the endothelial dysfunction and the high CV event rate among patients with RA.
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Affiliation(s)
- M Adawi
- Department of Medicine and the Rheumatology Unit, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
- Azrieli Faculty of Medicine, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - N Pastukh
- The Vascular Research Laboratory, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - G Saaida
- Azrieli Faculty of Medicine, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - R Sirchan
- Department of Medicine and the Rheumatology Unit, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
| | - A Watad
- Department of Medicine 'B', The Zabludowicz Center for Autoimmune Diseases, Sheba Medical Center, Tel-Hashomer, Israel
| | - A Blum
- Department of Medicine and the Rheumatology Unit, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
- Azrieli Faculty of Medicine, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
- The Vascular Research Laboratory, Baruch Padeh Medical Center, Bar Ilan University, Galilee, Israel
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11
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Akenroye AT, Kumthekar AA, Alevizos MK, Mowrey WB, Broder A. Implementing an Electronic Medical Record-Based Reminder for Cardiovascular Risk Screening in Rheumatoid Arthritis. Arthritis Care Res (Hoboken) 2017; 69:625-632. [PMID: 27390217 DOI: 10.1002/acr.22966] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Revised: 05/22/2016] [Accepted: 06/21/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Although cardiovascular disease (CVD) is the leading cause of death among individuals with rheumatoid arthritis (RA), CVD risks are not being assessed frequently and systematically in RA. We implemented an electronic medical record (EMR)-based reminder in a tertiary care center and assessed the effects of this intervention on CVD risk screening by rheumatologists and primary care providers. METHODS The EMR reminder was implemented in December 2013 and included the most recent value and target ranges for body mass index, blood pressure (BP), and lipid profiles. It was displayed for every rheumatology and primary care visit for all patients with the International Classification of Diseases, Ninth Revision code for RA (714.0). Lipid screening rates, as well as changes in BP and obesity rates were compared pre- and postimplementation. Factors associated with lipid screening postimplementation were assessed using multivariate logistic regression. RESULTS A total of 138 and 112 RA patients were seen in the outpatient clinics pre- and postimplementation, respectively. The demographic characteristics were similar in the pre- and postimplementation groups. Lipid screening rates were 50% preimplementation and 46% postimplementation (P = 0.58). There were no significant improvements in BP or obesity rates postimplementation. Factors associated with the higher odds of lipid screening included older age and history of diabetes mellitus. CONCLUSION Implementing an EMR reminder did not improve CVD risk screening among RA patients. Future research is needed to identify and address barriers to CVD screening, and to educate patients and providers about RA-related risks.
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Affiliation(s)
- Ayobami T Akenroye
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Anand A Kumthekar
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
| | - Michail K Alevizos
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York
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12
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Gossec L, Baillet A, Dadoun S, Daien C, Berenbaum F, Dernis E, Fayet F, Hudry C, Mezieres M, Pouplin S, Richez C, Saraux A, Savel C, Senbel E, Soubrier M, Sparsa L, Wendling D, Dougados M. Collection and management of selected comorbidities and their risk factors in chronic inflammatory rheumatic diseases in daily practice in France. Joint Bone Spine 2016; 83:501-9. [DOI: 10.1016/j.jbspin.2016.05.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 05/18/2016] [Indexed: 12/15/2022]
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13
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Emanuel G, Charlton J, Ashworth M, Gulliford MC, Dregan A. Cardiovascular risk assessment and treatment in chronic inflammatory disorders in primary care. Heart 2016; 102:1957-1962. [PMID: 27534979 PMCID: PMC5256394 DOI: 10.1136/heartjnl-2016-310111] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2016] [Revised: 07/13/2016] [Accepted: 07/13/2016] [Indexed: 12/12/2022] Open
Abstract
Objective To compare differences in cardiovascular (CV) risk factors assessment and management among patients with rheumatoid arthritis (RA) and inflammatory bowel disease (IBD) with that of matched controls. Methods A matched cohort study was conducted using primary care electronic health records for one London borough. All patients diagnosed with RA or IBD, and matched controls registered with local general practices on 12th of January 2014 were identified. The study compared assessment and treatment of CV risk factors (blood pressure, body mass index, cholesterol and smoking) in the year before, the year after, and 5 years after RA and IBD diagnosis. Results A total of 1121 patients with RA and 1875 patients with IBD were identified and matched with 4282 and, respectively, 7803 controls. Patients with RA were 25% (incidence rate ratio, 1.25, 95% CI 1.12 to 1.35) more likely to have a CV risk factor measured compared with matched controls. The difference declined to 8% (1.08, 1.04 to 1.14) over 5 years of follow-up. The corresponding figures for IBD were 26% (1.26, 1.16 to 1.38) and 10% (1.10, 1.05 to 1.15). Patients with RA showed higher antihypertensive prescription rates during 5 years of follow-up (OR, 1.37, 95% CI 1.14 to 1.65) and patients with IBD showed higher statin prescription rates in the year preceding diagnosis (2.30, 1.20 to 4.42). Incomplete CV risk assessment meant that QRISK scores could be calculated for less than a fifth (17%) and clinical recording of CV disease (CVD) risk scores among patients with RA and IBD was 11% and 6%, respectively. Conclusions The assessment and treatment of vascular risk in patients with RA and IBD in primary care is suboptimal, particularly with reference to CVD risk score calculation.
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Affiliation(s)
- G Emanuel
- Department of Primary Care and Public Health, King's College London, London, UK
| | - J Charlton
- Department of Primary Care and Public Health, King's College London, London, UK
| | - M Ashworth
- Department of Primary Care and Public Health, King's College London, London, UK
| | - M C Gulliford
- Department of Primary Care and Public Health, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, Kings' College London, London UK
| | - A Dregan
- Department of Primary Care and Public Health, King's College London, London, UK.,National Institute for Health Research Biomedical Research Centre at Guy's and St Thomas' National Health Service Foundation Trust, Kings' College London, London UK
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14
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Meissner Y, Zink A, Kekow J, Rockwitz K, Liebhaber A, Zinke S, Gerhold K, Richter A, Listing J, Strangfeld A. Impact of disease activity and treatment of comorbidities on the risk of myocardial infarction in rheumatoid arthritis. Arthritis Res Ther 2016; 18:183. [PMID: 27495156 PMCID: PMC4975917 DOI: 10.1186/s13075-016-1077-z] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2016] [Accepted: 07/15/2016] [Indexed: 12/29/2022] Open
Abstract
Background The aim was to estimate the impact of individual risk factors and treatment with various disease-modifying antirheumatic drugs (DMARDs) on the incidence of myocardial infarction (MI) in patients with rheumatoid arthritis (RA). Methods We analysed data from 11,285 patients with RA, enrolled in the prospective cohort study RABBIT, at the start of biologic (b) or conventional synthetic (cs) DMARDs. A nested case–control study was conducted, defining patients with MI during follow-up as cases. Cases were matched 1:1 to control patients based on age, sex, year of enrolment and five cardiovascular (CV) comorbidities. Generalized linear models were applied (Poisson regression with a random component, conditional logistic regression). Results In total, 112 patients developed an MI during follow-up. At baseline, during the first 6 months of follow-up and prior to the MI, inflammation markers (erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP)) but not 28-joint-count disease activity score (DAS28) were significantly higher in MI cases compared to matched controls and the remaining cohort. Baseline treatment with DMARDs was similar across all groups. During follow-up bDMARD treatment was significantly more often discontinued or switched in MI cases. CV comorbidities were significantly less often treated in MI cases vs. matched controls (36 % vs. 17 %, p < 0.01). In the adjusted regression model, we found a strong association between higher CRP and MI (OR for log-transformed CRP at follow-up: 1.47, 95 % CI 1.00; 2.16). Furthermore, treatment with prednisone ≥10 mg/day (OR 1.93, 95 % CI 0.57; 5.85), TNF inhibitors (OR 0.91, 95 % CI 0.40; 2.10) or other bDMARDs (OR 0.85, 95 % CI 0.27; 2.72) was not associated with higher MI risk. Conclusions CRP was associated with risk of MI. Our results underline the importance of tight disease control taking not only global disease activity, but also CRP as an individual marker into account. It seems irrelevant with which class of (biologic or conventional) DMARD effective control of disease activity is achieved. However, in some patients the available treatment options were insufficient or insufficiently used - regarding DMARDs to treat RA as well as regarding the treatment of CV comorbidities. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1077-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Yvette Meissner
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany.
| | - Angela Zink
- German Rheumatism Research Centre, Epidemiology Unit, and Charité University Medicine Berlin, Berlin, Germany
| | - Jörn Kekow
- Otto-von-Guericke University, Magdeburg, Germany
| | | | | | | | - Kerstin Gerhold
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | - Adrian Richter
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | - Joachim Listing
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
| | - Anja Strangfeld
- German Rheumatism Research Centre, Epidemiology Unit, Berlin, Germany
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15
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Barber CEH, Esdaile JM, Martin LO, Faris P, Barnabe C, Guo S, Lopatina E, Marshall DA. Gaps in Addressing Cardiovascular Risk in Rheumatoid Arthritis: Assessing Performance Using Cardiovascular Quality Indicators. J Rheumatol 2016; 43:1965-1973. [PMID: 27481908 DOI: 10.3899/jrheum.160241] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Cardiovascular disease (CVD) is a major comorbidity for patients with rheumatoid arthritis (RA). This study sought to determine the performance of 11 recently developed CVD quality indicators (QI) for RA in clinical practice. METHODS Medical charts for patients with RA (early disease or biologic-treated) followed at 1 center were retrospectively reviewed. A systematic assessment of adherence to 11 QI over a 2-year period was completed. Performance on the QI was reported as a percentage pass rate. RESULTS There were 170 charts reviewed (107 early disease and 63 biologic-treated). The most frequent CVD risk factors present at diagnosis (early disease) and biologic start (biologic-treated) included hypertension (26%), obesity (25%), smoking (21%), and dyslipidemia (15%). Performance on the CVD QI was highly variable. Areas of low performance (< 10% pass rates) included documentation of a formal CVD risk assessment, communication to the primary care physician (PCP) that patients with RA were at increased risk of CVD, body mass index documentation and counseling if overweight, communication to a PCP about an elevated blood pressure, and discussion of risks and benefits of antiinflammatories in patients at CVD risk. Rates of diabetes screening and lipid screening were 67% and 69%, respectively. The area of highest performance was observed for documentation of intent to taper corticosteroids (98%-100% for yrs 1 and 2, respectively). CONCLUSION Gaps in CVD risk management were found and highlight the need for quality improvements. Key targets for improvement include coordination of CVD care between rheumatology and primary care, and communication of increased CVD risk in RA.
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Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia. .,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary.
| | - John M Esdaile
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Liam O Martin
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Peter Faris
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Selynne Guo
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Elena Lopatina
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary; Alberta Health Services, Alberta; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Canada, Richmond, British Columbia; University of Toronto, Toronto, Ontario, Canada; University of Queensland, Brisbane, Australia.,C.E. Barber, MD, PhD, FRCPC, Assistant Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, FRCPC, FCAHS, Professor of Medicine, Division of Rheumatology, Department of Medicine, University of British Columbia, and Adjunct Professor of Medicine, University of Calgary, and Visiting Professor of Medicine, University of Queensland, and Scientific Director, Arthritis Research Canada; L.O. Martin, MB, MRCPI, FRCPC, Professor, Division of Rheumatology, Department of Medicine, Cumming School of Medicine, University of Calgary; P. Faris, PhD, Adjunct Associate Professor, Department of Community Health Sciences, University of Calgary, and Biostatistician, Research Support, Alberta Health Services; C. Barnabe, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, and Research Scientist, Arthritis Research Canada; S. Guo, BSc, Medical Student, University of Toronto; E. Lopatina, MD, MSc, Department of Community Health Sciences, Cumming School of Medicine, University of Calgary; D.A. Marshall, MHSA, PhD, Professor, Department of Community Health Sciences, and Arthur JE Child Chair in Rheumatology Research, Cumming School of Medicine, University of Calgary
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Baillet A, Gossec L, Carmona L, Wit MD, van Eijk-Hustings Y, Bertheussen H, Alison K, Toft M, Kouloumas M, Ferreira RJO, Oliver S, Rubbert-Roth A, van Assen S, Dixon WG, Finckh A, Zink A, Kremer J, Kvien TK, Nurmohamed M, van der Heijde D, Dougados M. Points to consider for reporting, screening for and preventing selected comorbidities in chronic inflammatory rheumatic diseases in daily practice: a EULAR initiative. Ann Rheum Dis 2016; 75:965-73. [DOI: 10.1136/annrheumdis-2016-209233] [Citation(s) in RCA: 141] [Impact Index Per Article: 17.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Accepted: 02/27/2016] [Indexed: 01/15/2023]
Abstract
In chronic inflammatory rheumatic diseases, comorbidities such as cardiovascular diseases and infections are suboptimally prevented, screened for and managed. The objective of this European League Against Rheumatism (EULAR) initiative was to propose points to consider to collect comorbidities in patients with chronic inflammatory rheumatic diseases. We also aimed to develop a pragmatic reporting form to foster the implementation of the points to consider. In accordance with the EULAR Standardised Operating Procedures, the process comprised (1) a systematic literature review of existing recommendations on reporting, screening for or preventing six selected comorbidities: ischaemic cardiovascular diseases, malignancies, infections, gastrointestinal diseases, osteoporosis and depression and (2) a consensus process involving 21 experts (ie, rheumatologists, patients, health professionals). Recommendations on how to treat the comorbidities were not included in the document as they vary across countries. The literature review retrieved 42 articles, most of which were recommendations for reporting or screening for comorbidities in the general population. The consensus process led to three overarching principles and 15 points to consider, related to the six comorbidities, with three sections: (1) reporting (ie, occurrence of the comorbidity and current treatments); (2) screening for disease (eg, mammography) or for risk factors (eg, smoking) and (3) prevention (eg, vaccination). A reporting form (93 questions) corresponding to a practical application of the points to consider was developed. Using an evidence-based approach followed by expert consensus, this EULAR initiative aims to improve the reporting and prevention of comorbidities in chronic inflammatory rheumatic diseases. Next steps include dissemination and implementation.
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Gherghe AM, Dougados M, Combe B, Landewé R, Mihai C, Berenbaum F, Mariette X, Wolterbeek R, van der Heijde D. Cardiovascular and selected comorbidities in early arthritis and early spondyloarthritis, a comparative study: results from the ESPOIR and DESIR cohorts. RMD Open 2015; 1:e000128. [PMID: 26535145 PMCID: PMC4623372 DOI: 10.1136/rmdopen-2015-000128] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Revised: 08/22/2015] [Accepted: 08/25/2015] [Indexed: 12/12/2022] Open
Abstract
Objectives To investigate the prevalence of comorbidities in early rheumatoid arthritis (ERA) and early axial spondyloarthritis (ESpA) versus the general population. Methods Baseline data of 689 patients with ERA from the Etude et Suivi des Polyarthrites Indifférenciées Récentes (ESPOIR) cohort (age 48.2±12.1 years, symptoms duration 14.2±14.5 weeks) and 645 patients with ESpA from Devenir des Spondylarthropathies Indifférenciées Récentes (DESIR; age 32.8±8.4 years, axial symptoms duration 79.0±45.7 weeks) were analysed. Metabolic and cardiovascular diseases (CVD), infections and neoplasia were determined in each cohort. The prevalence (95% CI) of several comorbidities was compared with that in the French general population. For patients without CVD, the 10-year risk of developing CVD was calculated using the Framingham and SCORE equations. The heart age was calculated using the 2008 Framingham points system. Results 42% of patients with ERA and 20.3% of patients with ESpA had at least 1 comorbidity; the most common were arterial hypertension (AHT) and dyslipidaemia. AHT prevalence (95% CI) in ERA (18.2% (15.5% to 21.3%)), but not in ESpA (5.08% (3.57% to 7.14%)), was significantly increased (p<0.05) compared with the general population (7.58%). Prevalence of tuberculosis history was higher in ERA (4.7% (3.3% to 6.6%)), and ESpA (0.99% (0.4% to 2.3%)) than in the general population (0.02%; both p<0.05). No differences were observed in malignancies, coronary heart disease or diabetes. In ERA, among patients without a history of CVD, an intermediate to high CVD risk was found. The heart age exceeded the real age by 4.1±9.6 years in ERA and by 2.1±7.0 years in ESpA (p<0.001). Conclusions We found an increased prevalence of AHT and tuberculosis history in ERA and ESpA, and an increased CVD risk. These results should prompt rheumatologists to check these comorbidities early in the disease.
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Affiliation(s)
- Ana Maria Gherghe
- Department of Rheumatology , Leiden University Medical Centre , Leiden , The Netherlands ; Department of Internal Medicine and Rheumatology , Cantacuzino Clinical Hospital , Bucharest , Romania
| | - Maxime Dougados
- Department of Rheumatology , Paris Descartes University-Hôpital Cochin, Assistance Publique-hôpitaux de Paris-INSERM (U1153): Clinical Epidemiology and Biostatistics, PRES Sorbonne Paris-Cité , Paris , France
| | - Bernard Combe
- Department of Rheumatology , Lapeyronie Hospital, Montpellier 1 University , Montpellier , France
| | - Robert Landewé
- Clinical Immunology and Rheumatology Department , Academic Research Center/University of Amsterdam, Atrium Medical Center Heerlen , Heerlen , The Netherlands
| | - Carina Mihai
- Department of Internal Medicine and Rheumatology , Cantacuzino Clinical Hospital , Bucharest , Romania
| | - Francis Berenbaum
- University Pierre et Marie Curie Paris VI, 7 quai Saint Bernard , Paris , France ; Department of Rheumatology , 2 AP-HP Saint-Antoine hospital, and Department Hospitalo-Universitaire Inflammation-Immunopathology-Biotherapy (I2B) , Paris , France
| | - Xavier Mariette
- Department of Rheumatology , Hôpitaux Universitaires Paris Sud, Université Paris Sud, AP-HP, INSERM U1012 , Le Kremlin-Bicêtre , France
| | - Ron Wolterbeek
- Department of Medical Statistics and Bioinformatics , Leiden University Medical Center , Leiden , The Netherlands
| | - Désirée van der Heijde
- Department of Rheumatology , Leiden University Medical Centre , Leiden , The Netherlands
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Ernste FC, Sánchez-Menéndez M, Wilton KM, Crowson CS, Matteson EL, Maradit Kremers H. Cardiovascular risk profile at the onset of psoriatic arthritis: a population-based cohort study. Arthritis Care Res (Hoboken) 2015; 67:1015-21. [PMID: 25581120 DOI: 10.1002/acr.22536] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Revised: 11/10/2014] [Accepted: 12/16/2014] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The role of cardiovascular disease (CVD) risk factors in psoriatic arthritis (PsA) is poorly understood. We examined the prevalence of CVD risk factors at initial onset of PsA and compared the observed incidence of CVD events with that predicted by the Framingham Risk Score (FRS) to determine its applicability in this patient population. METHODS A population-based incidence cohort of 158 patients with PsA who fulfilled Classification of Psoriatic Arthritis criteria for PsA in 1989-2008 was assembled. Medical records were reviewed to ascertain CVD risk factors and CVD events. Future risk of CVD was estimated using the FRS algorithm. RESULTS Mean age was 43.4 years (range 19-74 years), 61% were men, and 44% were obese (body mass index ≥30 kg/m(2) ). Fifty-four patients (34%) presented with ≥2 CVD risk factors at PsA incidence. Among 126 patients ages ≥30 years at PsA incidence with no prior history of CVD, 33% had an FRS ≥10%, with 11% having an FRS ≥20%, and 18 experienced a CVD event in the first 10 years of disease duration. The 10-year cumulative incidence of CVD events was 17% (95% confidence interval [95% CI] 10%-24%), almost twice as high as the predicted incidence based on the FRS (standardized incidence ratio 1.80, 95% CI 1.14-2.86; P = 0.012). CONCLUSION The majority of newly diagnosed PsA patients have a >10% risk of CVD within 10 years of PsA incidence. The CVD risk in these patients is higher than expected and underestimated by the FRS.
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Affiliation(s)
| | | | - K M Wilton
- Mayo Medical School and Graduate School of Medicine, Rochester, Minnesota
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Davis JM. Toward Quality of Cardiovascular Preventive Care for Patients with Rheumatic Diseases. J Rheumatol 2015; 42:1539-41. [PMID: 26330123 DOI: 10.3899/jrheum.150697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- John M Davis
- Consultant, Division of Rheumatology; Associate Professor of Medicine, College of Medicine, Mayo Clinic, Rochester, Minnesota, USA.
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Barber CEH, Marshall DA, Alvarez N, Mancini GBJ, Lacaille D, Keeling S, Aviña-Zubieta JA, Khodyakov D, Barnabe C, Faris P, Smith A, Noormohamed R, Hazlewood G, Martin LO, Esdaile JM. Development of Cardiovascular Quality Indicators for Rheumatoid Arthritis: Results from an International Expert Panel Using a Novel Online Process. J Rheumatol 2015; 42:1548-55. [PMID: 26178275 DOI: 10.3899/jrheum.141603] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 12/18/2022]
Abstract
OBJECTIVE Patients with rheumatoid arthritis (RA) have a high risk of premature cardiovascular disease (CVD). We developed CVD quality indicators (QI) for screening and use in rheumatology clinics. METHODS A systematic review was conducted of the literature on CVD risk reduction in RA and the general population. Based on the best practices identified from this review, a draft set of 12 candidate QI were presented to a Canadian panel of rheumatologists and cardiologists (n = 6) from 3 academic centers to achieve consensus on the QI specifications. The resulting 11 QI were then evaluated by an online modified-Delphi panel of multidisciplinary health professionals and patients (n = 43) to determine their relevance, validity, and feasibility in 3 rounds of online voting and threaded discussion using a modified RAND/University of California, Los Angeles Appropriateness Methodology. RESULTS Response rates for the online panel were 86%. All 11 QI were rated as highly relevant, valid, and feasible (median rating ≥ 7 on a 1-9 scale), with no significant disagreement. The final QI set addresses the following themes: communication to primary care about increased CV risk in RA; CV risk assessment; defining smoking status and providing cessation counseling; screening and addressing hypertension, dyslipidemia, and diabetes; exercise recommendations; body mass index screening and lifestyle counseling; minimizing corticosteroid use; and communicating to patients at high risk of CVD about the risks/benefits of nonsteroidal antiinflammatory drugs. CONCLUSION Eleven QI for CVD care in patients with RA have been developed and are rated as highly relevant, valid, and feasible by an international multidisciplinary panel.
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Affiliation(s)
- Claire E H Barber
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Deborah A Marshall
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Nanette Alvarez
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - G B John Mancini
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Diane Lacaille
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Stephanie Keeling
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - J Antonio Aviña-Zubieta
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Dmitry Khodyakov
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Cheryl Barnabe
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Peter Faris
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Alexa Smith
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Raheem Noormohamed
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Glen Hazlewood
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - Liam O Martin
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
| | - John M Esdaile
- From the Division of Rheumatology, Department of Medicine, and the Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research, the Division of Cardiology and the Department of Cardiovascular Sciences, and the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Alberta; Division of Cardiology and Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver; Arthritis Research Centre of Canada, Richmond, British Columbia; The RAND Corporation, Santa Monica, California, USA; Division of Rheumatology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of International Health, Johns Hopkins University School of Public Health, Baltimore, Maryland, USA.C.E. Barber, MD, FRCPC, PhD Candidate, Division of Rheumatology, Department of Medicine; D.A. Marshall, MHSA, PhD, Associate Professor, Department of Community Health Sciences, Arthur J.E. Child Chair in Rheumatology Research; N. Alvarez, MD, FRCPC, BA, Associate Professor, Division of Cardiology, Department of Cardiovascular Sciences, and Libin Cardiovascular Institute of Alberta, University of Calgary; G.B. Mancini, MD, FRCPC, Professor, Division of Cardiology; D. Lacaille, MD, FRCPC, MHSc, Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Senior Scientist, Arthritis Research Centre of Canada; S. Keeling, MD, FRCPC, MSc, Associate Professor, Division of Rheumatology, Department of Medicine, University of Alberta; J.A. Aviña-Zubieta, MD, MSc, PhD, Assistant Professor, Division of Rheumatology, Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada; D. Khodyakov, PhD, MA, Social/Behavioral Scientist, The RAND Corporation; C. Barnabe, MD, FRCPC, MSc, Assistant Professor, Division of Rheumatology, Department of Medicine, Department of Community Health Sciences, University of Calgary and ARC Research Sci
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EULAR task force recommendations on annual cardiovascular risk assessment for patients with rheumatoid arthritis: an audit of the success of implementation in a rheumatology outpatient clinic. BIOMED RESEARCH INTERNATIONAL 2015; 2015:515280. [PMID: 25815322 PMCID: PMC4359830 DOI: 10.1155/2015/515280] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 10/02/2014] [Indexed: 02/07/2023]
Abstract
Objective. EULAR recommendations for cardiovascular disease (CVD) risk management include annual CVD risk assessments for patients with rheumatoid arthritis (RA). We evaluated the recording of CVD risk factors (CVD-RF) in a rheumatology outpatient clinic, where EULAR recommendations had been implemented. Further, we compared CVD-RF recordings between a regular rheumatology outpatient clinic (RegROC) and a structured arthritis clinic (AC). Methods. In 2012, 1142 RA patients visited the rheumatology outpatient clinic: 612 attended RegROC and 530 attended AC. We conducted a search in the patient journals to ascertain the rate of CVD-RF recording. Results. The overall CVD-RF recording rate was 40.1% in the rheumatology outpatient clinic, reflecting a recording rate of 59.1% in the AC and 23.6% in the RegROC. The odds ratios for having CVD-RFs recorded for patients attending AC compared to RegROC were as follows: blood pressure: 12.4, lipids: 5.0-6.0, glucose: 9.1, HbA1c: 6.1, smoking: 1.4, and for having all the CVD-RFs needed to calculate the CVD risk by the systematic coronary risk evaluation (SCORE): 21.0. Conclusion. The CVD-RF recording rate was low in a rheumatology outpatient clinic. However, a systematic team-based model was superior compared to a RegROC. Further measures are warranted to improve CVD-RF recording in RA patients.
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Barber CEH, Smith A, Esdaile JM, Barnabe C, Martin LO, Faris P, Hazlewood G, Noormohamed R, Alvarez N, Mancini GBJ, Lacaille D, Keeling S, Aviña-Zubieta JA, Marshall D. Best Practices for Cardiovascular Disease Prevention in Rheumatoid Arthritis: A Systematic Review of Guideline Recommendations and Quality Indicators. Arthritis Care Res (Hoboken) 2015; 67:169-79. [DOI: 10.1002/acr.22419] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Accepted: 07/22/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Claire E. H. Barber
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | - Alexa Smith
- Dalhousie University, Halifax; Nova Scotia Canada
| | - John M. Esdaile
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Cheryl Barnabe
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Peter Faris
- University of Calgary and Alberta Health Services, Calgary; Alberta Canada
| | - Glen Hazlewood
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
| | | | - Nanette Alvarez
- University of Calgary and Libin Cardiovascular Institute of Alberta, Calgary; Alberta Canada
| | | | - Diane Lacaille
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | | | - J. Antonio Aviña-Zubieta
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond; British Columbia Canada
| | - Deborah Marshall
- University of Calgary and Arthritis Research Centre of Canada, Calgary; Alberta Canada
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Erfassung von Komorbiditäten. Z Rheumatol 2014; 73:501-2. [DOI: 10.1007/s00393-014-1464-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Choy E, Ganeshalingam K, Semb AG, Szekanecz Z, Nurmohamed M. Cardiovascular risk in rheumatoid arthritis: recent advances in the understanding of the pivotal role of inflammation, risk predictors and the impact of treatment. Rheumatology (Oxford) 2014; 53:2143-54. [PMID: 24907149 PMCID: PMC4241890 DOI: 10.1093/rheumatology/keu224] [Citation(s) in RCA: 205] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Risk of cardiovascular (CV) disease is increased among RA patients. High inflammatory burden associated with RA appears to be a key driver of the increased cardiovascular risk. Inflammation is linked with accelerated atherosclerosis and associated with a paradoxical inversion of the relationship between CV risk and lipid levels in patients with untreated RA, recently coined the lipid paradox. Furthermore, the inflammatory burden is also associated with qualitative as well as quantitative changes in lipoproteins, with the anti-inflammatory and atheroprotective roles associated with high-density lipoprotein cholesterol significantly altered. RA therapies can increase lipid levels, which may reflect the normalization of lipids due to their inflammatory-dampening effects. However, these confounding influences of inflammation and RA therapies on lipid profiles pose challenges for assessing CV risk in RA patients and interpretation of traditional CV risk scores. In this review we examine the relationship between the increased inflammatory burden in RA and CV risk, exploring how inflammation influences lipid profiles, the impact of RA therapies and strategies for identifying and monitoring CV risk in RA patients aimed at improving CV outcomes.
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Affiliation(s)
- Ernest Choy
- Section of Rheumatology, Cardiff University School of Medicine, Cardiff, UK, Global Medical Affairs, F. Hoffmann-La Roche, Basel, Switzerland, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary and Departments of Internal Medicine and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Kandeepan Ganeshalingam
- Section of Rheumatology, Cardiff University School of Medicine, Cardiff, UK, Global Medical Affairs, F. Hoffmann-La Roche, Basel, Switzerland, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary and Departments of Internal Medicine and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Anne Grete Semb
- Section of Rheumatology, Cardiff University School of Medicine, Cardiff, UK, Global Medical Affairs, F. Hoffmann-La Roche, Basel, Switzerland, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary and Departments of Internal Medicine and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Zoltán Szekanecz
- Section of Rheumatology, Cardiff University School of Medicine, Cardiff, UK, Global Medical Affairs, F. Hoffmann-La Roche, Basel, Switzerland, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary and Departments of Internal Medicine and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands
| | - Michael Nurmohamed
- Section of Rheumatology, Cardiff University School of Medicine, Cardiff, UK, Global Medical Affairs, F. Hoffmann-La Roche, Basel, Switzerland, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, Department of Rheumatology, Institute of Medicine, University of Debrecen, Debrecen, Hungary and Departments of Internal Medicine and Rheumatology, VU University Medical Center, Amsterdam, The Netherlands.
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Honey A, Major G. Management of comorbidities in patients with complex diseases: who is responsible? Intern Med J 2014; 44:619. [DOI: 10.1111/imj.12452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2014] [Accepted: 04/09/2014] [Indexed: 12/01/2022]
Affiliation(s)
- A. Honey
- Department of Rheumatology, Bone and Joint Institute; The Royal Newcastle Centre; Newcastle New South Wales Australia
| | - G. Major
- Department of Rheumatology, Bone and Joint Institute; The Royal Newcastle Centre; Newcastle New South Wales Australia
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Semb AG, Rollefstad S, van Riel P, Kitas GD, Matteson EL, Gabriel SE. Cardiovascular disease assessment in rheumatoid arthritis: a guide to translating knowledge of cardiovascular risk into clinical practice. Ann Rheum Dis 2014; 73:1284-8. [DOI: 10.1136/annrheumdis-2013-204792] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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The role of rheumatologists vis-à-vis assessment of traditional cardiovascular risk factors in rheumatoid arthritis. Clin Rheumatol 2014; 33:769-74. [PMID: 24526251 DOI: 10.1007/s10067-014-2522-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2013] [Revised: 01/20/2014] [Accepted: 01/29/2014] [Indexed: 11/27/2022]
Abstract
This study was designed to estimate the burden of care that would be placed on rheumatologists to undertake cardiovascular (CV) risk assessment of traditional CV risk factors in their patients. This cross-sectional study was set in a rheumatology ambulatory clinic of a tertiary care, university hospital. Consecutive rheumatoid arthritis (RA) patients were recruited over 6 weeks and matched 1:1 on age and sex to patients with non-inflammatory problems who presented to the same clinic. CV risk was calculated using the Framingham Risk Score. We recruited 68 RA patients and 64 controls. The distribution of CV risk factors in RA patients and controls was similar. Ten-year Framingham CV risk scores based on traditional risk factors were moderate and similar in RA patients and controls (13.7 and 14.3%, respectively). Nevertheless, the proportion of RA patients with a history of coronary artery disease was more than twice that of controls (13 versus 5%, respectively). Approximately 20% of RA patients and controls did not have a primary care physician. In rheumatology practice, the problem of elevated CV risk due to traditional risk factors is not unique to RA patients. The burden for rheumatologists of undertaking CV risk assessment in their clinic could be considerable. Rheumatologists should manage inflammatory disease and health services should be improved to ensure the optimal management of traditional CV risk factors for all rheumatology patients.
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Dougados M, Soubrier M, Antunez A, Balint P, Balsa A, Buch MH, Casado G, Detert J, El-Zorkany B, Emery P, Hajjaj-Hassouni N, Harigai M, Luo SF, Kurucz R, Maciel G, Mola EM, Montecucco CM, McInnes I, Radner H, Smolen JS, Song YW, Vonkeman HE, Winthrop K, Kay J. Prevalence of comorbidities in rheumatoid arthritis and evaluation of their monitoring: results of an international, cross-sectional study (COMORA). Ann Rheum Dis 2013; 73:62-8. [PMID: 24095940 PMCID: PMC3888623 DOI: 10.1136/annrheumdis-2013-204223] [Citation(s) in RCA: 528] [Impact Index Per Article: 48.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Background Patients with rheumatoid arthritis (RA) are at increased risk of developing comorbid conditions. Objectives To evaluate the prevalence of comorbidities and compare their management in RA patients from different countries worldwide. Methods Study design: international, cross-sectional. Patients: consecutive RA patients. Data collected: demographics, disease characteristics (activity, severity, treatment), comorbidities (cardiovascular, infections, cancer, gastrointestinal, pulmonary, osteoporosis and psychiatric disorders). Results Of 4586 patients recruited in 17 participating countries, 3920 were analysed (age, 56±13 years; disease duration, 10±9 years (mean±SD); female gender, 82%; DAS28 (Disease Activity Score using 28 joints)–erythrocyte sedimentation rate, 3.7±1.6 (mean±SD); Health Assessment Questionnaire, 1.0±0.7 (mean±SD); past or current methotrexate use, 89%; past or current use of biological agents, 39%. The most frequently associated diseases (past or current) were: depression, 15%; asthma, 6.6%; cardiovascular events (myocardial infarction, stroke), 6%; solid malignancies (excluding basal cell carcinoma), 4.5%; chronic obstructive pulmonary disease, 3.5%. High intercountry variability was observed for both the prevalence of comorbidities and the proportion of subjects complying with recommendations for preventing and managing comorbidities. The systematic evaluation of comorbidities in this study detected abnormalities in vital signs, such as elevated blood pressure in 11.2%, and identified conditions that manifest as laboratory test abnormalities, such as hyperglycaemia in 3.3% and hyperlipidaemia in 8.3%. Conclusions Among RA patients, there is a high prevalence of comorbidities and their risk factors. In this multinational sample, variability among countries was wide, not only in prevalence but also in compliance with recommendations for preventing and managing these comorbidities. Systematic measurement of vital signs and laboratory testing detects otherwise unrecognised comorbid conditions.
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Affiliation(s)
- Maxime Dougados
- Medicine Faculty, Paris-Descartes University, , Paris, France
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Kreitenberg AJ, Quismorio FP, Hsieh EP, Ben-Ari R, Panush RS. Improving the Care of Patients With Rheumatic Diseases Who Have Cardiovascular Risk: Comment on the Article by Gossec et al. Arthritis Care Res (Hoboken) 2013; 65:1548-9. [DOI: 10.1002/acr.22002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Adam J. Kreitenberg
- Keck School of Medicine at University of Southern California; Los Angeles; CA
| | | | - Eric P. Hsieh
- Keck School of Medicine at University of Southern California; Los Angeles; CA
| | - Ron Ben-Ari
- Keck School of Medicine at University of Southern California; Los Angeles; CA
| | - Richard S. Panush
- Keck School of Medicine at University of Southern California; Los Angeles; CA
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Need for evidence based Indian guidelines for cardiovascular risk assessment in rheumatoid arthritis. INDIAN JOURNAL OF RHEUMATOLOGY 2013. [DOI: 10.1016/j.injr.2013.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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